Provider Demographics
NPI:1710317938
Name:SULLIVAN, ELIZABETH (MFT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:582 MARKET ST
Mailing Address - Street 2:SUITE 1109
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94104-5301
Mailing Address - Country:US
Mailing Address - Phone:415-508-7086
Mailing Address - Fax:
Practice Address - Street 1:582 MARKET ST
Practice Address - Street 2:SUITE 1109
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94104-5301
Practice Address - Country:US
Practice Address - Phone:415-508-7086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-25
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA77529106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA77529OtherSTATE OF CA MFT LICENSE